Helicobacter Pylori Treatment Research Articles

Vonoprazan vs. Proton Pump Inhibitors for Treatment and Prevention of Gastric and/or Duodenal Ulcers: A Systematic Review with Meta-Analysis.

Although Vonoprazan, a potassium-competitive acid blocker, is superior to proton pump inhibitors (PPIs) in treating Helicobacter pylori and erosive esophagitis, its efficacy for treating gastric and/or duodenal ulcers remains controversial. This meta-analysis summarizes the efficacy and safety of Vonoprazan vs. PPI for treating and preventing gastric and/or duodenal ulcers. Only randomized controlled trials randomizing gastric and/or duodenal ulcer patients, regardless of etiology, into Vonoprazan or any PPI and indexed in Embase, Medline, and CENTRAL until March 2, 2024 were searched. Primary outcomes were ulcer healing rates at Weeks 2, 4, 6, and 8 and recurrence rates at Week 24. Other outcomes included shrinkage rates, any adverse events (AEs), serious AEs (SAEs), and risks of delayed bleeding and perforation. The overall risk ratio (RR) and mean difference were pooled using the random-effects model. The risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB2) Tool. Fifteen studies comprising 43 reports were included in the analysis. Healing rates of gastric and/or duodenal ulcers were similar in both Vonoprazan and PPI groups at all weeks (Week 2 RR 1.02 [95%CI 0.89-1.16]; Week 4 0.99 [95% CI 0.95-1.04]; Week 6 1.00 [95% CI 0.96-1.03]; Week 8 0.99 [95% CI 0.95-1.03]). The recurrence prevention of peptic ulcers was not different in Vonoprazan 10mg (RR 0.48; 95% CI 0.18-1.27) or 20mg (0.60; 95% CI 0.28-1.30) to PPI. Shrinkage rates, any AEs, SAEs, and risks of delayed bleeding and perforation were similar in both groups. Vonoprazan is not significantly better than PPI in treating and preventing gastric and/or duodenal ulcers.

Prevention of Gastric Cancer: Helicobacter pylori Treatment

<i>Helicobacter pylori</i> infection has been associated with various gastric diseases, including ulcers, adenomas, and adenocarcinomas. Over 40 years since the discovery of <i>H. pylori</i>, numerous studies have shown that <i>H. pylori</i> eradication therapy can help prevent gastric cancer not only in healthy individuals but also in patients who have already been treated for early gastric cancer. Moreover, some studies have shown that eradication therapy can improve gastric mucosal inflammatory diseases, such as atrophic changes and intestinal metaplasia. This article reviews the epidemiology of <i>H. pylori</i> infections and gastric cancer, mechanisms of <i>H. pylori</i>-associated gastric cancer development, and current evidence supporting the benefits of <i>H. pylori</i> eradication for reducing or preventing gastric cancer.

Vonoprazan-amoxicillin dual therapy for Helicobacter pylori eradication in Chinese population: A prospective, multicenter, randomized, two-stage study.

The efficacy of Vonoprazan-amoxicillin dual therapy (VAT) in the treatment of Helicobacter pylori (H. pylori) is controversial. To evaluate the efficacy of VAT in the Chinese population. This prospective, multicenter, randomized, open-label, and two-stage study was conducted at 23 centers in Fujian, China (May 2021-April 2022). H. pylori-infected patients were randomized to bismuth quadruple therapy (BQT), BQT-Vonoprazan (BQT-V), seven-day VAT (VAT-7), ten-day VAT (VAT-10), and fourteen-day VAT (VAT-14) groups. The primary endpoint was the H. pylori eradication rate. The secondary endpoint was the frequency of adverse events. This study was registered with the Chinese Clinical Trial Registry, ChiCTR2100045778. In the first stage, VAT-7 and BQT-V groups were selected for early termination because less than 23 among 28 cases were eradicated. In the second stage, the eradication rates for BQT, VAT-10, and VA-14 were 80.2% [95% confidence interval (95%CI): 71.4%-86.8%], 93.2% (86.6%-96.7%), 92.2% (85.3%-96.0%) in the intention-to-treat (ITT) analysis, and 80.9% (95%CI: 71.7%-87.5%), 94.0% (87.5%-97.2%), and 93.9% (87.4%-97.2%) in the per-protocol analysis. The ITT analysis showed a higher eradication rate in the VAT-10 and VAT-14 groups than in the BQT group (P = 0.022 and P = 0.046, respectively). The incidence of adverse events in the VAT-10 and VAT-14 groups was lower than in the BQT group (25.27% and 13.73% vs 37.62%, respectively; P < 0.001). VAT with a duration of 10 or 14 days achieves a higher eradication rate than the BQT, with a more tolerable safety profile in H. pylori-infected patients in Fujian.

Mechanism of Weiwei granules in the treatment of chronic active Helicobacter pylori gastritis with atrophy based on the TLR4/NF-κB/COX-2 inflammatory signaling pathway.

Our paper aimed to elucidate the mechanism of Weiwei granules in the treatment of Helicobacter pylori (Hp)-positive chronic atrophic gastritis (CAG) based on the TLR4/NF-κB/COX-2 inflammatory signaling pathway. Hp-positive CAG patients were randomized into the control group (treated with quadruple therapy) or the observation group (treated with Weiwei granules based on the control group). The clinical efficacy, Hp clearance rate, and efficacy of traditional Chinese medicine (TCM) symptoms were compared between the two groups after six months of treatment. The scores of various histopathology variables, serum levels of inflammatory factors (interleukin-6 [IL-6], interleukin-8 [IL-8], and tumor necrosis factor-alpha [TNF-α]), gastrin-17 (G-17) and motilin (MTL), pepsinogen (PG) I and PG II, as well as serum levels of gastrointestinal hormone endothelin (ET), epidermal growth factor (EGF), and calcitonin gene-related peptide (CGRP), were compared between the two groups before and after treatment. TLR4, NF-κB, and COX-2 mRNA levels were compared in gastric mucosal tissues before and after treatment in the two groups. After treatment, the clinical efficacy, Hp clearance rate, and efficacy of TCM symptoms of patients in the observation group were higher than those in the control group. After treatment, the scores of various histopathology variables, serum levels of inflammatory factors (IL-6, IL-8, and TNF-α), gastrointestinal hormones (ET and EGF), and the expression levels of TLR4, NF-κB, and COX-2 mRNA in the gastric mucosal tissues were lower and G-17, MTL, CGRP, and PG I levels were higher in the observation group than in the control group. Weiwei granules can effectively improve Hp-positive CAG patients and reduce the expression levels of TLR4, NF-κB, and COX-2.

Helicobacter pylori Treatment and Gastric Cancer Risk Among Individuals With High Genetic Risk for Gastric Cancer

Helicobacter pylori treatment and nutrition supplementation may protect against gastric cancer (GC), but whether the beneficial effects only apply to potential genetic subgroups and whether high genetic risk may be counteracted by these chemoprevention strategies remains unknown. To examine genetic variants associated with the progression of gastric lesions and GC risk and to assess the benefits of H pylori treatment and nutrition supplementation by levels of genetic risk. This cohort study used follow-up data of the Shandong Intervention Trial (SIT, 1989-2022) and China Kadoorie Biobank (CKB, 2004-2018) in China. Based on the SIT, a longitudinal genome-wide association study was conducted to identify genetic variants for gastric lesion progression. Significant variants were examined for incident GC in a randomly sampled set of CKB participants (set 1). Polygenic risk scores (PRSs) combining independent variants were assessed for GC risk in the remaining CKB participants (set 2) and in an independent case-control study in Linqu. H pylori treatment and nutrition supplementation. Primary outcomes were the progression of gastric lesions (in SIT only) and the risk of GC. The associations of H pylori treatment and nutrition supplementation with GC were evaluated among SIT participants with different levels of genetic risk. Our analyses included 2816 participants (mean [SD] age, 46.95 [9.12] years; 1429 [50.75%] women) in SIT and 100 228 participants (mean [SD] age, 53.69 [11.00] years; 57 357 [57.23%] women) in CKB, with 147 GC cases in SIT and 825 GC cases in CKB identified during follow-up. A PRS integrating 12 genomic loci associated with gastric lesion progression and incident GC risk was derived, which was associated with GC risk in CKB (highest vs lowest decile of PRS: hazard ratio [HR], 2.54; 95% CI, 1.80-3.57) and further validated in the analysis of 702 case participants and 692 control participants (mean [SD] age, 54.54 [7.66] years; 527 [37.80%] women; odds ratio, 1.83; 95% CI, 1.11-3.05). H pylori treatment was associated with reduced GC risk only for individuals with high genetic risk (top 25% of PRS: HR, 0.45; 95% CI, 0.25-0.82) but not for those with low genetic risk (HR, 0.81; 95% CI, 0.50-1.34; P for interaction = .03). Such effect modification was not found for vitamin (P for interaction = .93) or garlic (P for interaction = .41) supplementation. The findings of this cohort study indicate that a high genetic risk of GC may be counteracted by H pylori treatment, suggesting primary prevention could be tailored to genetic risk for more effective prevention.

Cutting-edge Nanotechnology Approaches in Peptic Ulcer Therapy

Abstract: The ulcer is a chronic disease that penetrates the gastrointestinal tract and produces a deep lesion. One type of ulcer is peptic ulcer, which leads to the development of a lesion on the lining (mucosa) of the digestive tract. Various drugs are used for the treatment, including antibiotics, but don't provide correct eradication, so for the excellence in therapeutic value and decreasing side effects, nanotechnology is being used. Nanotechnology is a technique that is nowadays used in trend because of its outstanding efficacy and also its effect at both cellular and molecular levels. Based on this technology, nanoparticles are used for the treatment of peptic ulcers. This review focuses on the treatment approaches for peptic ulcers by using nanotechnology. Some nanoparticles used in the treatment of Helicobacter pylori (H. pylori) are metallic nanoparticles, polymeric nanoparticles, targeting nanoparticles, and a new technology arrived is membrane coated nanoparticles, which are very advantageous for H. pylori treatment. The purpose of this review is to overview and gain attention to the limitations in treatment (like antibiotic resistance) and also the new strategies to overcome them and enhance the properties of nanoparticles to produce the anti-bacterial effect. This development helps in the treatment of H. pylori.

Treatment of Helicobacter pylori with potassium competitive acid blockers: A systematic review and meta-analysis.

Helicobacter pylori (H. pylori) infects over half the global population, causing gastrointestinal diseases like dyspepsia, gastritis, duodenitis, peptic ulcers, G-MALT lymphoma, and gastric adenocarcinoma. Eradicating H. pylori is crucial for treating and preventing these conditions. While conventional proton pump inhibitor (PPI)-based triple therapy is effective, there's growing interest in longer acid suppression therapies. Potassium competitive acid blocker (P-CAB) triple and dual therapy are new regimens for H. pylori eradication. Initially used in Asian populations, vonoprazan (VPZ) has been recently Food and Drug Administration-approved for H. pylori eradication. To assess the efficacy of regimens containing P-CABs in eradicating H. pylori infection. This study, following PRISMA 2020 guidelines, conducted a systematic review and meta-analysis by searching MEDLINE and Scopus libraries for randomized clinical trials (RCTs) or observational studies with the following command: [("Helicobacter pylori" OR "H pylori") AND ("Treatment" OR "Therapy" OR "Eradication") AND ("Vonaprazan" OR "Potassium-Competitive Acid Blocker" OR "P-CAB" OR "PCAB" OR "Revaprazan" OR "Linaprazan" OR "Soraprazan" OR "Tegoprazan")]. Studies comparing the efficacy of P-CABs-based treatment to classical PPIs in eradicating H. pylori were included. Exclusion criteria included case reports, case series, unpublished trials, or conference abstracts. Data variables encompassed age, diagnosis method, sample sizes, study duration, intervention and control, and H. pylori eradication method were gathered by two independent reviewers. Meta-analysis was performed in R software, and forest plots were generated. A total of 256 references were initially retrieved through the search command. Ultimately, fifteen studies (7 RCTs, 7 retrospective observational studies, and 1 comparative unique study) were included, comparing P-CAB triple therapy to PPI triple therapy. The intention-to-treat analysis involved 8049 patients, with 4471 in the P-CAB intervention group and 3578 in the PPI control group across these studies. The analysis revealed a significant difference in H. pylori eradication between VPZ triple therapy and PPI triple therapy in both RCTs and observational studies [risk ratio (RR) = 1.17, 95% confidence interval (CI): 1.11-1.22, P < 0.0001] and (RR = 1.13, 95%CI: 1.09-1.17, P < 0.0001], respectively. However, no significant difference was found between tegoprazan (TPZ) triple therapy and PPI triple therapy in both RCTs and observational studies (RR = 1.04, 95%CI: 0.93-1.16, P = 0.5) and (RR = 1.03, 95%CI: 0.97-1.10, P = 0.3), respectively. VPZ-based triple therapy outperformed conventional PPI-based triple therapy in eradicating H. pylori, positioning it as a highly effective first-line regimen. Additionally, TPZ-based triple therapy was non-inferior to classical PPI triple therapy.

A comparative analysis of univariate versus multivariate eco-friendly spectrophotometric manipulations for resolving severely overlapped spectra of vonoprazan and amoxicillin new combination

Vonoprazan and amoxicillin are pharmacological combinations that demonstrate synergistic effects in treating Helicobacter pylori (H. pylori), a global public health concern associated with peptic ulcer disease and gastric cancer. Four spectrophotometric methods were developed, including two univariate techniques (Fourier self-deconvolution and ratio difference) and two multivariate chemometric approaches (partial least squares and principal component regression). These methods provide innovative solutions for effectively resolving and accurately quantifying the overlapping spectra of vonoprazan and amoxicillin. The concentration ranges covered were 3–60 μg ml−1 for vonoprazan and 5–140 μg ml−1 for amoxicillin. To assess the environmental sustainability of the methodologies, various measures such as the Green Analytical Procedure Index (GAPI), National Environmental Method Index (NEMI), Analytical GREEnness Calculator, and Analytical Eco-scale, as well as RGB12 and hexagon toll were implemented. The validation of the developed techniques was carried out in compliance with ICH standards. The present study is highly significant because it is the first time that the mixture has been determined using the current approaches. The comparative analysis demonstrated no significant difference in terms of accuracy and precision compared to reference HPLC method (p = 0.05). The established spectrophotometric methods offer a straightforward, rapid, and cost-effective alternative to complex analytical techniques for determining the vonoprazan and amoxicillin mixture. They show potential for routine analysis in research laboratories and pharmaceutical industries.

Facilitators of and barriers to gastric cancer and precursor diagnosis among South Texas residents: Social determinants of health.

Latinos/Hispanics are at higher risk for developing gastric cancer (GC) compared with non-Hispanic whites, and social determinants of health (SDoH) are thought to contribute. This study addressed SDoH and their interactions contributing to disparities in the testing and treatment of Helicobacter pylori (HP) infection and diagnosis of GC and its known precursors, among Latinos/Hispanics relative to non-Latinos at two affiliated but independent health systems in San Antonio, Texas, using a mixed methods approach. Secondary data abstraction and analysis showed that GCs represented 2.6% (n = 600) of our population. Men and older individuals were at higher GC risk. Individuals with military insurance were 2.7 times as likely to be diagnosed as private insurance. Latinos/Hispanics had significantly (24%) higher GC risk than Whites. Poverty and lack of insurance contributed to GC risk among the minorities classified as other (Asians, Native Americans, Multiracial; all p < 0.01). All SDoH were associated with H. pylori infection (p < 0.001). Qualitative analysis of patient and provider interviews showed providers reporting insurance as a major care barrier; patients reported appointment delays, and lack of clinic staff. Providers universally agreed treatment of H. pylori was necessary, but disagreed on its prevalence. Patients did not report discussing H. pylori or its cancer risk with providers. These data indicate the importance of considering SDoH in diagnosis and treatment of GC and its precursors, and educating providers and patients on H. pylori risks for GC.

Treatment of Helicobacter Pylori İnfection and the Colonization of the Gastrointestinal System by Resistant Bacteria.

Helicobacter pylori (H. pylori) infections are widely treated with antibiotic regimens such as "Amoxicillin 1 gr 2 × 1 tablet, Clarithromycin 500 mg 2 × 1 tablet, and Lansoprazole 30 mg 2 × 1 tablet" for 14 days. We conducted a prospective observational study to explore whether this treatment protocol serves as a predisposing factor for the colonization of resistant gastrointestinal microflora, namely vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase Enterobacterales (ESBL-E), and carbapenem-resistant Enterobacterales (CRE). Pre- and post-treatment stool samples from 75 patients diagnosed with H. pylori, without a prior treatment history, were cultured and evaluated based on the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Of the 75 evaluated patients, a pronounced surge in ESBL-E positivity was observed. Before initiating antibiotic treatment, 12 patients (16%) had ESBL-E-positive strains in their gastrointestinal tract. Notably, this number surged to 24 patients (32%) after the conclusion of the 14-day treatment regimen. The change was statistically significant, with a P value of less than 0.002, indicating a clear association between treatment for H. pylori and heightened ESBL-E colonization. Notably, VRE and CRE remained undetected in patients throughout the study, suggesting that the treatment regimen may specifically amplify the risk of ESBL-E colonization without affecting VRE and CRE prevalence. As the inaugural report from Turkey on this issue, our study suggests that antibiotic regimens for H. pylori eradication contribute to the increased risk of ESBL-positive bacterial colonization in the gastrointestinal tract.

Investigating the mechanism of Banxia Xiexin Decoction in treating Helicobacter pylori-associated chronic atrophic gastritis through network pharmacology and molecular docking

ObjectiveThe aim of this study was to investigate the mechanism of Banxia Xiexin Decoction in treating Helicobacter pylori (HP)-associated chronic atrophic gastritis (CAG) using network pharmacology methods. MethodsDifferential genes between HP-associated CAG and healthy individuals were screened from the Gene Expression Omnibus (GEO) database using high-throughput gene expression data. The compounds and targets of Banxia Xiexin Decoction were obtained from the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database. ResultsThrough screening, 217 differentially expressed genes were obtained. Banxia Xiexin Decoction contained a total of 211 active components corresponding to 258 target genes. Nine key targets, including DPP4, SLC6A4, CYP3A4, HMOX1, MGAM, MTTP, APOB, UGT1A1, and CASP1, were identified. The enrichment analysis showed that Banxia Xiexin Decoction exerted its therapeutic effects on HP-associated CAG by participating in biological processes such as energy metabolism, oxidative reactions, cell apoptosis, anti-inflammatory response, and immune response, as well as regulating drug metabolism processes, heme and chlorophyll metabolism, steroid hormone biosynthesis, and retinol metabolism pathways. ConclusionThe main active components of Banxia Xiexin Decoction are quercetin, ellagic acid, and genistein, and it exerts its therapeutic effects on HP-associated chronic atrophic gastritis through a mechanism involving multiple components, targets, and pathways.

Mucoadhesive Microspheres: A Promising Delivery System for Helicobacter Pylori (H. pylori) Treatment.

A major worldwide health problem, Helicobacter Pylori (H. pylori) infection is associated with a number of gastrointestinal disorders, such as gastric cancer and peptic ulcers. The shortcomings of traditional treatment plans often include adverse effects, low patient compliance, and the emergence of antibiotic resistance. Investigating different delivery methods is thus necessary to improve the effectiveness of treatment. Mucoadhesive microspheres show promise as a method for delivering anti H. pylori drugs in a targeted and sustained manner. With their ability to stick to the stomach mucosa, these microspheres increase the local concentration of the medication and guarantee a more thorough removal of the pathogen. The potential of Mucoadhesive microspheres in the management of H. pylori infection is examined in this review. We explore the properties and benefits of Mucoadhesive polymers, the production techniques for microspheres, and the variables affecting their functionality. To provide a thorough grasp of this delivery system, a variety of drug-loading strategies, release mechanisms, and in vitro and in vivo assessment methodologies are covered. The potential of Mucoadhesive microspheres to overcome the drawbacks of traditional therapy is shown by highlighting recent developments in their formulation and their therapeutic consequences. Mucoadhesive microspheres constitute an important advancement in the treatment of Helicobacter pylori because they guarantee a regulated release of antibiotics and improve medication absorption at the site of infection. In order to fully appreciate the advantages of this novel delivery method, further study is necessary. Future research paths and the difficulties in the clinical translation of this technology are also discussed.

Machine learning models in predicting failure of Helicobacter pylori treatment: A two country validation study

AbstractBackgroundThe success rate of clarithromycin‐containing Helicobacter pylori treatment had declined globally. This study aims to explore the role of different machine learning algorithms in predicting failure of H. pylori treatment.Materials and MethodsWe included 84,609 adult patients who had received the first course of clarithromycin‐containing triple therapy for H. pylori in Hong Kong from 2003 to 2013 as training set. Results were validated in patients who had received similar triple therapy with 27,736 Hong Kong patients between 2014 and 2017 (internal cohort); and 18,050 UK patients between 2012 and 2017 (external cohort). The performance of 11 available machine learning algorithms were used to predict the failure of triple therapy. The performance was determined by the area under receiver operating characteristic curve (AUC).ResultsThe treatment failure rates in the training, internal and external validation cohort was 5.9%, 9.5%, and 6.1%, respectively. In the internal validation set, Extra‐Tree (ET) Classifier had the best AUC (0.88; 95% CI, 0.87–0.88), sensitivity (79.6%; 95% CI, 79.0–80.2) and specificity (79.4%; 95% CI, 79.0–79.8). In the external validation set, ET Classifier also had the best AUC (0.85; 95% CI, 0.85–0.86), sensitivity (80.1%; 95% CI, 79.5–80.9), and specificity (80.2%; 95% CI, 78.8–81.3). Top features of importance used by ET Classifier in predicting treatment failure included time interval between antibiotic use and triple therapy (48.8%), age (29.1%) and triple therapy regime (6.28%).ConclusionsMachine learning algorithm, based on simple baseline clinical parameters, could help to identify patients at high risk of failure from clarithromycin‐containing triple therapy for H. pylori.

In silico antibacterial, anticancer, antioxidant, antidiabetic activity predictions of the dual organic peroxide 2,5-dimethyl-2,5-di(tert-butyl peroxyl)hexane

In this search organic peroxide has been studied for its potential biological activities in various fields, including medicine and biotechnology. Molecular docking studies have been conducted to predict the binding between organic peroxide and certain biological targets, such as the breast cancer receptor 3hb5-oxidoreductase and the prostate cancer mutant 2q7k-Hormone. The docking results indicate potential interactions between peroxide and these targets. In addition to its potential cytotoxic activity, organic peroxide has been investigated for its antidiabetic activity. The docking results suggest that peroxide binds to the active site of enzymes involved in diabetes, such as α-amylase, pancreatic lipase, and β-glucosidase, with low binding energies. This indicates a potential role for peroxide in the treatment of diabetes. Furthermore, the interaction between peroxide and the antioxidant protein IHD2 (2HCK) has been explored. These computational studies suggest a possible pharmacological role for peroxide in the treatment of Helicobacter pylori (H. pylori) infection. The docking energy between peroxide and Helicobacter pylori adhesin HopQ type I bound to the N-terminal domain of human CEACAM1 indicates that peroxide could be a potential target to inhibit H. pylori infection. It’s important to note that these findings are based on computational methods and molecular docking studies. Further research, including in vitro and in vivo experiments, would be necessary to validate these findings and fully understand the potential benefits and limitations of peroxide in these applications.

659. Geographical Clustering of the Likelihood of Treatment in Histologically Diagnosed Helicobacter pylori in the BOSTON-HP Cohort

Abstract Background The BIDMC Optimization &amp; Standardization for Treatment Outcomes in New England for Helicobacter Pylori (BOSTON-HP) study included 1002 patients with confirmed Helicobacter pylori (HP) via gastric histopathology from 2016-2022 to evaluate the effects of a Multidisciplinary Division Wide Program. Our previous data showed that demographic factors, such as race/ethnicity and preferred language, are associated with treatment, test-of-cure, and eradication outcomes. We hypothesize that given an unlikely even geographic distribution of demographic factors, HP outcomes may cluster geographically. Methods The BOSTON-HP cohort patient addresses were transformed to georeferenced coordinates which were mapped using QGIS (3.30 's-Hertogenbosch) onto OpenStreetMap. We calculated the maximum Euclidean distance matrix to assign heatmap weights for each outcome, and calculated global spatial autocorrelation to evaluate the extent of spatial clustering. Results Eight hundred and sixty-eight patients (86.6%) received treatment with confirmed eradication in 416 (47.9%) of them. A statistically significant positive spatial autocorrelation of clusters (Moran’s I = 0.080, p =0.003, z=2.787) was observed for the likelihood of treatment. Layering transportation and healthcare units revealed key clustering patterns (see Figures 1. &amp; 2.). Clusters in the vicinity of Longwood Medical Area (LMA), and South Cove Medical Center (SCMC) were more likely to receive treatment, while those in the Brighton collegiate area (BCA) and along the Red Line Axis in Roxbury-Dorchester (RLRD) were less likely to receive treatment. Test-of-cure and eradication success were not statistically significant for clustering (Moran’s I = 0.007, p =0.388, z=0.284) (Moran’s I = 0.006, p =0.441, z=0.149), respectively.Figure 1. BOSTON-HP Treatment Cohort.Figure 2. Untreated in the BOSTON-HP Cohort. Conclusion A moderate and significant spatial correlation existed between the likelihood of HP treatment and the geographic location of the patient’s residence. Identification of groups for targeted quality improvement interventions (RLRD) and models of success within the system (SCMC) can help improve treatment outcomes and reduce geographic disparities. Disclosures Javier Villafuerte-Gálvez, MD, Milky Way Biosciences: Partial Research Support.

Acute Psychotic Episode Induced by Helicobacter Pylori Treatment.

Acute Psychotic Episode Induced by Helicobacter Pylori Treatment.

Recent Advances in Diagnosing and Treating Helicobacter pylori through Botanical Extracts and Advanced Technologies

Helicobacter pylori (H. pylori) infection is a major global health concern, with an estimated 50% of the world's population infected. The bacterium colonizes the stomach and is associated with a range of gastrointestinal diseases, including chronic gastritis, peptic ulcers, and gastric cancer. The current standard of care for H. pylori infection involves a combination of antibiotics and proton pump inhibitors (PPIs), but the widespread use of antibiotics has led to the development of antibiotic-resistant strains of H. pylori, making treatment more difficult. Recent advances in diagnostic strategies include the use of non-invasive tests and serological biomarkers. While the use of antibiotics and PPIs remains the primary treatment approach, there is a growing interest in alternative therapies, including botanical extracts, natural products, and traditional medicines. Recent research has also explored the potential of probiotics, phage therapy, and novel antibiotics, such as rifabutin and furazolidone, in the treatment of H. pylori infection. Recent studies have also explored the potential of artificial intelligence (AI) in the diagnosis and management of H. pylori infection. AI-assisted screening methods have identified novel botanical extracts and natural products with anti-H. pylori activity, providing new avenues for therapeutic development. Additionally, AI can improve diagnostic accuracy and treatment outcomes. Although these alternative approaches show promise, further research is needed to confirm their efficacy, safety, and optimal dosing. Novel therapies such as phage therapy and new antibiotics may provide an alternative to traditional treatments and help overcome antimicrobial resistance.

Helicobacter pylori Treatment and Gastric Cancer Risk After Endoscopic Resection of Dysplasia: A Nationwide Cohort Study

Background and aimsThe aim of this study was to investigate the association between Helicobacter pylori treatment and the risk of gastric cancer after endoscopic resection (ER) of gastric dysplasia. MethodsPatients who received ER for gastric dysplasia between 2010 and 2020 from Korean nationwide insurance data were included. We verified the occurrence of new-onset gastric cancer and metachronous gastric neoplasm, which encompasses both cancer and dysplasia, more than a year after the index ER. Newly diagnosed gastric cancer ≥3 years and ≥5 years was regarded as late-onset gastric cancer. A multivariable Cox regression model with H. pylori treatment status as a time-dependent covariate was used to determine the risk of gastric cancer and metachronous gastric neoplasms. ResultsOf the 69,722 patients with gastric dysplasia and were treated with endoscopy, 49.5% were administered H. pylori therapy. During the median 5.6 years of follow-up, 2,406 and 3,342 patients developed gastric cancer and metachronous gastric neoplasms, respectively. Receiving H. pylori therapy was closely related to lower gastric cancer risk (adjusted hazard ratio [aHR] 0.88; 95% confidence interval [CI], 0.80-0.96). H. pylori treatment also significantly decreased metachronous gastric neoplasm development (aHR 0.76; 95% CI, 0.70-0.82). Furthermore, H. pylori therapy showed a prominent protective effect for late-onset gastric cancer development (aHR, 0.84 [95% CI, 0.75-0.94] for ≥ 3 years; aHR, 0.80 [95% CI, 0.68-0.95] for ≥ 5 years). ConclusionIn this nationwide cohort, H. pylori therapy after endoscopic resection of gastric dysplasia was associated with a reduced risk of gastric cancer and metachronous gastric neoplasm occurrence.

Co-administration of amoxicillin-loaded chitosan nanoparticles and inulin: A novel strategy for mitigating antibiotic resistance and preserving microbiota balance in Helicobacter pylori treatment

Helicobacter pylori (H. pylori) is a causative agent of various gastrointestinal diseases and eradication mainly relies on antibiotic treatment, with (AMX) being a key component. However, rising antibiotic resistance in H. pylori necessitates the use of antibiotics combination therapy, often disrupting gut microbiota equilibrium leading to further health complications. This study investigates a novel strategy utilizing AMX-loaded chitosan nanoparticles (AMX-CS NPs), co-administered with prebiotic inulin to counteract H. pylori infection while preserving microbiota health. Following microbroth dilution method, AMX displayed efficacy against H. pylori, with a MIC50 of 48.34 ± 3.3 ng/mL, albeit with a detrimental impact on Lactobacillus casei (L. casei). The co-administration of inulin (500 μg/mL) with AMX restored L. casei viability while retaining the lethal effect on H. pylori. Encapsulation of AMX in CS-NPs via ionic gelation method, resulted in particles of 157.8 ± 3.85 nm in size and an entrapment efficiency (EE) of 86.44 ± 2.19 %. Moreover, AMX-CS NPs showed a sustained drug release pattern over 72 h with no detectable toxicity on human dermal fibroblasts cell lines. Encapsulation of AMX into CS NPs also reduced its MIC50 against H. pylori, while its co-administration with inulin maintained L. casei viability. Interestingly, treatment with AMX-CS NPs also reduced the expression of the efflux pump gene hefA in H. pylori. This dual treatment strategy offers a promising approach for more selective antimicrobial treatment, minimizing disruption to healthy microbial communities while effectively addressing pathogenic threats.

Treatment of Helicobacter pylori in the Arab world: a systematic review and network meta-analysis

Treatment of Helicobacter pylori in the Arab world: a systematic review and network meta-analysis